Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer.
Journal
Prostate cancer and prostatic diseases
ISSN: 1476-5608
Titre abrégé: Prostate Cancer Prostatic Dis
Pays: England
ID NLM: 9815755
Informations de publication
Date de publication:
10 Apr 2024
10 Apr 2024
Historique:
received:
15
02
2024
accepted:
03
04
2024
revised:
28
03
2024
medline:
11
4
2024
pubmed:
11
4
2024
entrez:
10
4
2024
Statut:
aheadofprint
Résumé
While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP. We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes. While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients. Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.
Sections du résumé
BACKGROUND
BACKGROUND
While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP.
METHODS
METHODS
We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes.
RESULTS
RESULTS
While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients.
CONCLUSIONS
CONCLUSIONS
Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.
Identifiants
pubmed: 38600321
doi: 10.1038/s41391-024-00831-1
pii: 10.1038/s41391-024-00831-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10:63–89.
doi: 10.14740/wjon1191
pubmed: 31068988
pmcid: 6497009
Khafagy R, Shackley D, Samuel J, O’Flynn K, Betts C, Clarke N. Complications arising in the final year of life in men dying from advanced prostate cancer. J Palliat Med. 2007;10:705–11.
doi: 10.1089/jpm.2006.0185
pubmed: 17592982
Tang M, Wang C, Li P, Zhang Q, Qian J, Meng X. Efficacy and outcome of holmium laser enucleation of prostate in patients with urinary retention due to advanced prostate cancer. Lasers Med Sci. 2020;35:1307–13.
doi: 10.1007/s10103-019-02913-2
pubmed: 31768690
Moul JW, Davis R, Vaccaro JA, Sihelnik SA, Belville WD, McLeod DG. Acute urinary retention associated with prostatic carcinoma. J Urol. 1989;141:1375–7.
doi: 10.1016/S0022-5347(17)41312-7
pubmed: 2470926
Crain DS, Amling CL, Kane CJ. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer. J Urol. 2004;171:668–71.
doi: 10.1097/01.ju.0000104845.24632.92
pubmed: 14713783
Hagmann S, Ramakrishnan V, Tamalunas A, Hofmann M, Vandenhirtz M, Vollmer S, et al. Two decades of active surveillance for prostate cancer in a single-center cohort: favorable outcomes after transurethral resection of the prostate. Cancers. 2022;14:368.
doi: 10.3390/cancers14020368
pubmed: 35053530
pmcid: 8773913
McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793–803.
doi: 10.1016/j.juro.2011.01.074
pubmed: 21420124
Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, et al. Holmium laser enucleation of the prostate: A truly size-independent method? Low Urin Tract Symptoms. 2022;14:17–26.
Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia. Urology 1996;47:48–51.
doi: 10.1016/S0090-4295(99)80381-1
pubmed: 8560662
Gravas S, Malde S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, et al. From BPH to male LUTS: a 20-year journey of the EAU guidelines. Prostate Cancer Prostatic Dis. 2024;27:48–53.
Pyrgidis N, Mykoniatis I, Lusuardi L, Schulz GB, Sokolakis I, Stief C, et al. Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis. Prostate Cancer Prostatic Dis. 2023;26:693–701.
doi: 10.1038/s41391-023-00677-z
pubmed: 37193777
Das AK, Han TM, Hardacker TJ. Holmium laser enucleation of the prostate (HoLEP): size-independent gold standard for surgical management of benign prostatic hyperplasia. Can J Urol. 2020;27:44–50.
pubmed: 32876002
Park S, Kwon T, Park S, Moon KH. Efficacy of Holmium Laser Enucleation of the prostate in patients with a small prostate (</=30 mL). World J Mens Health. 2017;35:163–9.
doi: 10.5534/wjmh.17011
pubmed: 29164833
pmcid: 5746487
Michalak J, Tzou D, Funk J. HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol. 2015;3:36–42.
pubmed: 26069886
pmcid: 4446381
Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Hennenberg M, et al. Efficacy, efficiency, and safety of En-bloc vs. Three-lobe Enucleation of the prostate: a propensity score-matched analysis. Urology. 2023;175:48–55.
doi: 10.1016/j.urology.2023.02.014
pubmed: 36828266
Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, et al. The clinical value of holmium laser enucleation of the prostate in octogenarians. Low Urin Tract Sympt. 2021;13:279–85.
Westhofen T, Weinhold P, Kolb M, Stief CG, Magistro G. Evaluation of Holmium laser enucleation of the prostate learning curves with and without a structured training programme. Curr Urol. 2020;14:191–9.
doi: 10.1159/000499239
pubmed: 33488337
pmcid: 7810216
Becker A, Placke A, Kluth L, Schwarz R, Isbarn H, Chun F, et al. Holmium laser enucleation of the prostate is safe in patients with prostate cancer and lower urinary tract symptoms–a retrospective feasibility study. J Endourol. 2014;28:335–41.
doi: 10.1089/end.2013.0432
pubmed: 24147796
Lee MS, Assmus MA, Guo J, Siddiqui MR, Ross AE, Krambeck AE. Relationships between holmium laser enucleation of the prostate and prostate cancer. Nat Rev Urol. 2023;20:226–40.
doi: 10.1038/s41585-022-00678-y
pubmed: 36418491
Mazur AW, Thompson IM. Efficacy and morbidity of “channel” TURP. Urology 1991;38:526–8.
doi: 10.1016/0090-4295(91)80170-C
pubmed: 1746080
Cornu JN, Gacci, M, Hashim, C, Herrmann, TRW, Malde, S, Netsch, C, et al. Management of Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). EAU Guidelines Edn presented at the EAU Annual Congress Milan March 2023 ISBN 978-94-92671-19-6. 2023.
Mottet N, Cornford, P, van den Bergh, RCN, Briers, E, Eberli, D, De Meerleer, G, et al. EAU - EANM - ESTRO - ESUR - ISUP - SIOG Guidelines on Prostate Cancer. EAU Guidelines Edn presented at the EAU Annual Congress Milan 2023 ISBN 978-94-92671-19-6. 2023.
Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F. The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol. 2011;29:205–10.
doi: 10.1007/s00345-010-0566-y
pubmed: 20461386
Esper P, Redman BG. Supportive care, pain management, and quality of life in advanced prostate cancer. Urol Clin North Am. 1999;26:375–89.
doi: 10.1016/S0094-0143(05)70077-X
pubmed: 10361560
Oefelein MG. Prognostic significance of obstructive uropathy in advanced prostate cancer. Urology 2004;63:1117–21.
doi: 10.1016/j.urology.2004.01.026
pubmed: 15183963
Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160–6.
doi: 10.1016/j.eururo.2007.08.036
pubmed: 17869409
Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7:S3–S14.
pubmed: 16985902
pmcid: 1477638
Magistro G, Keller P, Westhofen T, Schott M, Tamalunas A, Weinhold P, et al. The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates. World J Urol. 2021;39:1481–87.
Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, et al. The impact of preoperative lower urinary tract symptoms medication on the functional performance of holmium laser enucleation of the prostate. Cent European J Urol. 2021;74:429–36.
Ghafar MA, Puchner PJ, Anastasiadis AG, Cabelin MA, Buttyan R. Does the prostatic vascular system contribute to the development of benign prostatic hyperplasia? Curr Urol Rep. 2002;3:292–6.
doi: 10.1007/s11934-002-0051-2
pubmed: 12149160
Shah HN, Kausik V, Hegde S, Shah JN, Bansal MB. Evaluation of fluid absorption during holmium laser enucleation of prostate by breath ethanol technique. J Urol. 2006;175:537–40.
doi: 10.1016/S0022-5347(05)00239-9
pubmed: 16406990
Marszalek M, Ponholzer A, Rauchenwald M, Madersbacher S. Palliative transurethral resection of the prostate: functional outcome and impact on survival. BJU Int. 2007;99:56–9.
doi: 10.1111/j.1464-410X.2006.06529.x
pubmed: 17034496
Elshal AM, Elmansy HM, Elhilali MM. Transurethral laser surgery for benign prostate hyperplasia in octogenarians: safety and outcomes. Urology 2013;81:634–9.
doi: 10.1016/j.urology.2012.11.042
pubmed: 23332997